Surgical complications and outcomes of Living Kidney Recipients in a Novice Transplant Center in the Sub-Saharan African Country- Ethiopia: A two years experience

  • Tekleberhan Berhe

Abstract

Background

End stage renal disease (ESRD) is emerging as a major public health problem worldwide.  Kidney transplantation is the treatment of choice for patients with ESRD, but its attendant surgical complications pose significant concern to the outcome of kidney transplantation surgery. Objective:

To review surgical complications and outcomes of live donor kidney transplant recipients in our centre.

Methods

We retrospectively analyzed all surgical complications among kidney transplant recipients performed from September 2015 to August 2017.

Results:

  A total of 52 live related kidney transplant surgeries were performed during this period. The male to female ratio was 3.3:1. Patient age range from 16 to 60years with mean age of 34.5years (SD= 10.4). BMI of patients ranged from 15.3 to 30.6kg/m2 with mean of 20.1(SD=3.5). The majority of patients received kidney from siblings 24(46.2%).

 The etiology of ESRD was unknown in 63.5% of cases, whereas chronic glomerulonephritis, diabetes mellitus and hypertension accounted for 13.5%, 7.7% and 3.8% respectively.

Post surgical complications occurred in 8patients (15.3%) and most complications were related to surgical wound (9.6%).There was one urologic complication (1.9%) due to ureteric kink. Lymphocele occurred in 1 patient (1.9%).

Conclusion:

With proper planning and support, kidney transplant surgery can be a safe treatment modality for patients with ESRD even in a resource limited facility. Our rates of surgical complications were within those reported by other series.

Key words: ESRD, Kidney transplantation, surgical complications

References

1.Okunola O Akinsola A, Ayodele O. Kidney diseases in Africa: aetiological considerations, peculiarities and burden.Afr J Med Med Sci.2012 Jun;41(2):119-33.
2.Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. NEJM 1999;341(23):1725–1730
3. Meier-Kriesche HU, Schold JD, Srinivas TR, Reed A, Kaplan B. Kidney transplantation halts cardiovascular disease progression in patients with end-stage renal disease. Am J Transplant 2004;4(10):1662–1668.
4. Davis CL, Delmonico FL. Living-donor kidney transplantation: A review of the current practices for the live donor. J Am Soc Nephrol 2005;16:2098-110.
5. Garcia-Garcia G, Harden P, Chapman J; World Kidney Day Steering Committee 2012. The global role of kidney transplantation Nephrology (Carlton) 2012;17:199-203.
6. McDonald S, Russ G. Survival of recipients of cadaveric kidney transplants compared with those receiving dialysis treatment in Australia and New Zealand, 1991-2001. Nephrol Dial Transplant 2002;17:2212-9
7. Haller M, Gutjahr G, Kramar R, et al. Cost-effectiveness analysis of renal replacement therapy in Austria. Nephrol Dial Transplant. 2011;26:2988–2995. [PubMed]
8. Domínguez J, Harrison R, Atal R. Cost-benefit estimation of cadaveric kidney transplantation: the case of a developing country. Transplant Proc. 2011;43:2300–2304. [PubMed
9. Merrill JP, Murray JE, Harrison JH. Successful homotransplantations of the human kidney between identical twins. JAMA. 1956;160:277
10. Humar A Matas AJ. Surgical complications after kidney transplantation. Semin Dial 2005, 18 :505–510.
11. Kobayashi K, Censullo ML, Rossman LL. Interventional radiologic management of renal transplant dysfunction: indications, limitations, and technical considerations. Radiographics. 2007;27:1109.[PubMed]
12. Sampaio FJ, Passos MA: Renal arteries. Anatomic study for surgical and radiological practice. Surg Radiol Anat. 1992: 14: 113-7
13. Emiroglu R, Karakayali H, Seumis S, et al. Urologic complications in 1275 consecutive renal transplantations. Transplant Proc. 2001;33:2016–7
14. Brown ED, Chen MYM, Wolfman NT. Complications of renal transplantation: evaluation with US and radionuclide imaging. Radiographics 2000;20:607e22
15. Okafor UH. Kidney transplant in Nigeria: a single centre experience. The Pan African Medical Journal. 2016;25:112. doi:10.11604/pamj.2016.25.112.7930.
16.Naicker S. Burden of end-stage renal disease in sub-Saharan Africa. Clin Nephrol. 2010;74 (Suppl 1:S13–S16. [PubMed]
17 .Diouf B, Ka EF, Niang A, et al. Etiologies of chronic renal insufficiency in adult internal medicine services in Dakar. Dakar Med. 2000;45:62–65. [PubMed]
18. Eufrásio P, Parada B, Moreira P, et al. Surgical complications in 2000 renal transplants. Transplant Proc. 2011;43:142–4. doi: 10.1016/j.transproceed.2010.12.009. [PubMed]
19. Guedea, M. (2017). Outcomes and Surgical Complications in Kidney Transplantation. International Journal of Organ Transplantation Medicine, 8(2), 78–84.
20. Kocak T Urological and surgical complications in 362 consecutive living related donor kidney transplantations. Urol.Int.2004;72(3):252-6.
21. Anthony D. Harris1, Brandon Fleming2, Jonathan S. Bromberg3, Peter Rock4, Grace Nkonge5, Michele Emerick5, Michelle Harris-Williams5, and Kerri A. Thom. Surgical Site Infection after Renal Transplantation. Infect Control Hosp Epidemiol. 2015 April ; 36(4): 417–423. doi:10.1017/ice.2014.77.
22. Menezes FG, Wey SB, Peres CA, Medina-Pestana JO, Camargo LF. Risk factors for surgical site infection in kidney transplant recipients. Infect Control Hosp Epidemiol. 2008 Aug;29(8):771-3. doi: 10.1086/589725.
23. Benedeti E, Short- and long-term outcomes of kidney transplants with multiple renal arteries,Ann Surg. 1995 Apr;(221) (4):406-14
24. Ali-El-Dien B . Multiple arteries in live donor renal transplantation: surgical aspects and outcomes, J Urol, 2003 Jun;169(6):2013-7


Okunola O Akinsola A, Ayodele O. Kidney diseases in Africa: aetiological considerations, peculiarities and burden.Afr J Med Med Sci.2012 Jun;41(2):119-33.
2.Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. NEJM 1999;341(23):1725–1730
3. Meier-Kriesche HU, Schold JD, Srinivas TR, Reed A, Kaplan B. Kidney transplantation halts cardiovascular disease progression in patients with end-stage renal disease. Am J Transplant 2004;4(10):1662–1668.
4. Davis CL, Delmonico FL. Living-donor kidney transplantation: A review of the current practices for the live donor. J Am Soc Nephrol 2005;16:2098-110.
5. Garcia-Garcia G, Harden P, Chapman J; World Kidney Day Steering Committee 2012. The global role of kidney transplantation Nephrology (Carlton) 2012;17:199-203.
6. McDonald S, Russ G. Survival of recipients of cadaveric kidney transplants compared with those receiving dialysis treatment in Australia and New Zealand, 1991-2001. Nephrol Dial Transplant 2002;17:2212-9
7. Haller M, Gutjahr G, Kramar R, et al. Cost-effectiveness analysis of renal replacement therapy in Austria. Nephrol Dial Transplant. 2011;26:2988–2995. [PubMed]
8. Domínguez J, Harrison R, Atal R. Cost-benefit estimation of cadaveric kidney transplantation: the case of a developing country. Transplant Proc. 2011;43:2300–2304. [PubMed
9. Merrill JP, Murray JE, Harrison JH. Successful homotransplantations of the human kidney between identical twins. JAMA. 1956;160:277
10. Humar A Matas AJ. Surgical complications after kidney transplantation. Semin Dial 2005, 18 :505–510.
11. Kobayashi K, Censullo ML, Rossman LL. Interventional radiologic management of renal transplant dysfunction: indications, limitations, and technical considerations. Radiographics. 2007;27:1109.[PubMed]
12. Sampaio FJ, Passos MA: Renal arteries. Anatomic study for surgical and radiological practice. Surg Radiol Anat. 1992: 14: 113-7
13. Emiroglu R, Karakayali H, Seumis S, et al. Urologic complications in 1275 consecutive renal transplantations. Transplant Proc. 2001;33:2016–7
14. Brown ED, Chen MYM, Wolfman NT. Complications of renal transplantation: evaluation with US and radionuclide imaging. Radiographics 2000;20:607e22
15. Okafor UH. Kidney transplant in Nigeria: a single centre experience. The Pan African Medical Journal. 2016;25:112. doi:10.11604/pamj.2016.25.112.7930.
16.Naicker S. Burden of end-stage renal disease in sub-Saharan Africa. Clin Nephrol. 2010;74 (Suppl 1:S13–S16. [PubMed]
17 .Diouf B, Ka EF, Niang A, et al. Etiologies of chronic renal insufficiency in adult internal medicine services in Dakar. Dakar Med. 2000;45:62–65. [PubMed]
18. Eufrásio P, Parada B, Moreira P, et al. Surgical complications in 2000 renal transplants. Transplant Proc. 2011;43:142–4. doi: 10.1016/j.transproceed.2010.12.009. [PubMed]
19. Guedea, M. (2017). Outcomes and Surgical Complications in Kidney Transplantation. International Journal of Organ Transplantation Medicine, 8(2), 78–84.
20. Kocak T Urological and surgical complications in 362 consecutive living related donor kidney transplantations. Urol.Int.2004;72(3):252-6.
21. Anthony D. Harris1, Brandon Fleming2, Jonathan S. Bromberg3, Peter Rock4, Grace Nkonge5, Michele Emerick5, Michelle Harris-Williams5, and Kerri A. Thom. Surgical Site Infection after Renal Transplantation. Infect Control Hosp Epidemiol. 2015 April ; 36(4): 417–423. doi:10.1017/ice.2014.77.
22. Menezes FG, Wey SB, Peres CA, Medina-Pestana JO, Camargo LF. Risk factors for surgical site infection in kidney transplant recipients. Infect Control Hosp Epidemiol. 2008 Aug;29(8):771-3. doi: 10.1086/589725.
23. Benedeti E, Short- and long-term outcomes of kidney transplants with multiple renal arteries,Ann Surg. 1995 Apr;(221) (4):406-14
24. Ali-El-Dien B . Multiple arteries in live donor renal transplantation: surgical aspects and outcomes, J Urol, 2003 Jun;169(6):2013-7
Published
2020-03-30